Placebo Economics: A Systematic Review About the Economic Potential of Utilizing the Placebo Effect

Background: Recent research shows that placebo mechanisms can be utilized in ethical and legal ways such as in open-label conditions, when patients know that they receive placebos, and through psychological interventions aiming to optimize patients’ expectations. Showing that placebo interventions are also cost-efficient could improve their acceptability. Objective: To review studies that performed health economic evaluations (HEEs) of intentional placebo interventions and to review studies that intentionally applied placebo interventions and reported outcomes eligible for HEEs. Methods: Two systematic reviews of the literature were performed. For the first review, we searched MEDLINE using “placebo” and Medical Subject Headings (MeSH) terms associated with HEEs such as “costs,” “cost–benefit analyses,” and “economics.” Studies were eligible if they employed patients, applied placebo interventions, included an appropriate control group, and reported results of cost analyses. For the second review, we searched the Journal of Interdisciplinary Placebo Studies (JIPS) database and MEDLINE using search terms for outcomes eligible for cost–utility analyses, such as “quality of life” or “quality-adjusted life years” (“QALYs”). Risk of bias of all studies found was assessed according to the Cochrane Handbook, and a narrative synthesis of the results is provided. Results: The first search resulted in 1,853 articles, which were screened for eligibility. Two studies were found only in which costs or cost-effectiveness analysis were reported, but with medium to high risks of biases. The second search yielded 164 articles particularly from the JIPS database of which 11 studies met our search criteria: in six studies, patients received placebo pills in open-label conditions; three studies investigated effects of patient–physician relationships; and two studies used psychological interventions to optimize treatment expectations, in patients with various diseases and disorders. These studies report outcomes potentially eligible for HEEs when costs of interventions were known. Risks of biases were low to medium, but patients were not blinded to the conditions in most studies. Conclusions: The state of knowledge about HEEs of placebo interventions is scarce. To gain more visibility and acceptability for placebo interventions, future studies should measure outcomes usable for HEEs and costs of interventions, and HEEs should be performed for existing studies if data are available

Nährstoffgehalte im Torf und ausgewählten Moorpflanzen unter dem Einfluss erhöhter N- und P-Verfügbarkeit – Ergebnisse eines 3-jährigen Düngungsexperimentes

Hohe atmosphärische N-Depositionen können den Nährstoffhaushalt und die Vegetation von natürlicherweise überwiegend N-limitierten oligotrophen Mooren nachhaltig beeinflussen. In einem 34 Monate andauernden Gefäßversuch wurden an 20 ungestörten Torfmonolithen aus dem Blumentopfmoor (Nationalpark Harz) die Effekte von vier verschiedenen Düngevarianten (50kg N ha-1 a-1, 100kg N ha-1 a-1, 3kg P ha-1 a-1, 50 kg N + 3 kg P ha-1 a-1) und einer Kontrolle (keine Düngung) auf die Moorvegetation, die sich aus Sphagnum magellanicum (Sm), Eriophorum angustifolium (Ea) und Vaccinium oxycoccus (Vo) zusammensetzte, untersucht. Ergebnisse zu den untersuchten Parametern Trockenmasse, C-, N- und P-Gehalte sowie C:N- und N:P- Verhältnisse der genannten, nach ober- (1) und unterirdischen (2) Teilen getrennten, Pflanzenarten werden vorgestellt. Signifikante Unterschiede zur Kontrolle zeigte Ea (1 und 2) in der 50kgN+3kgP-Variante mit knapp dreimal höheren Trockenmassen. Vergleichsweise geringe Sm - Torf (2) – Trockenmassen in der 100kgN- und 50kgN + 3kgP-Variante deuten in Verbindung mit höheren N-Gehalten und folglich geringeren C/N-Verhältnissen auf günstigere Zersetzungsbedingungen hin. Weiterhin lässt die geringe Vitalität der Torfmoospflanzen in der 100kgN-Variante eine Wachstumshemmung infolge der N-Düngung vermuten. Während sich anhand der N:P Verhältnisse für Ea bei der 0-Variante eine N-Limitierung abzeichnete, waren Vo und Sm überwiegend P-limitiert

An endocytic-secretory cycle participates in Toxoplasma gondii in motility

Apicomplexan parasites invade host cells in an active process involving their ability to move by gliding motility. While the acto-myosin system of the parasite plays a crucial role in the formation and release of attachment sites during this process, there are still open questions regarding the involvement of other mechanisms in parasite motility. In many eukaryotes, a secretory-endocytic cycle leads to the recycling of receptors (integrins), necessary to form attachment sites, regulation of surface area during motility, and generation of retrograde membrane flow. Here, we demonstrate that endocytosis operates during gliding motility in Toxoplasma gondii and appears to be crucial for the establishment of retrograde membrane flow, because inhibition of endocytosis blocks retrograde flow and motility. We demonstrate that extracellular parasites can efficiently incorporate exogenous material, such as labelled phospholipids, nanogold particles (NGPs), antibodies, and Concanavalin A (ConA). Using labelled phospholipids, we observed that the endocytic and secretory pathways of the parasite converge, and endocytosed lipids are subsequently secreted, demonstrating the operation of an endocytic-secretory cycle. Together our data consolidate previous findings, and we propose an additional model, working in parallel to the acto-myosin motor, that reconciles parasite motility with observations in other eukaryotes: an apicomplexan fountain-flow-model for parasite motility

Erste Ergebnisse zum Wasser- und Stoffhaushalt eines wiedervernässten Moores im Nationalpark Harz

In differenzierten Moorarealen eines wiedervernässten Moores (Blumentopfmoor) im Nationalpark Harz wurden relevante Parameter des Wasser- und Stoffhaushaltes (Moorwasser, Abfluss und Torf) untersucht. Die Untersuchungen zeigten Parameterunterschiede im entwässerten und regenerierten Moorareal mit signifikant niedrigeren Wasserständen, höheren elektrischen Leitfähigkeiten und mineralischen Nährstoffgehalten im Moorwasser und Torf sowie höheren Trockenrohdichten im entwässerten Bereich, die auf den Einfluss der Entwässerung hindeuten. Weiterhin wurden ein signifikanter Anstieg der Wasserstände in den von der Wiedervernässung betroffenen Bereichen sowie abnehmende Nitrat-Gehalte im Moorwasser festgestellt. Nach den Wiedervernässungsmaßnahmen deuten ansteigende Phosphor(-P)gehalte im Moorwasser und abnehmende P-Gehalte im Torf auf eine erhöhte P-Mobilisierung hin

Veränderungen der Lachgas- und Methanflüsse eines nährstoffarmen Moores im Nationalpark Harz bei fortschreiten-der Wiedervernässung

Wiedervernässte Moore stellen dynamische Systeme dar, die eine hohe Mobilität gelöster organischer Kohlenstoffverbindungen (DOC) sowie hohe Methan(CH4)-Emissionen aufweisen können. Im vorliegenden Projekt wurden die Veränderungen der CH4- als auch Lachgas(N2O)-Emissionen mit fortschreitender Wiedervernässung einer permanent wasserüberstauten Fläche (Rew2009) und einer parallel zu den Gasmessungen wiedervernässten Fläche mit kontinuierlichem Anstieg der Wasserstände (Rew2010) mittels geschlossener Sammelhauben untersucht. Die bisherigen vierjährigen Untersuchungen zeigten sehr hohe CH4-Emissionen von bis zu 15,3 mg m-2 h-1 bei Rew2009. Signifikante Korrelationen wurden zwischen der CH4-Freisetzung zu den Bodentemperaturen,DOC- und Sauerstoff(O2)-Gehalten und den elektrischen Leitfähigkeiten des Moorwassers ermittelt. Signifikant niedrigere CH4-Emissionen und ein Anstieg der CH4-Emissionen mit fortschreitender Wiedervernässung wurden bei Rew2010 nachgewiesen. Während die permanent wassergesättigte Fläche Rew2009 negative bzw. sehr geringe N2O-Emissionen aufwies, wurden bei Rew2010 zu Beginn der Wiedervernässung bei niedrigen Wasserständen höhere N2O-Emissionen von im Mittel bis zu 37 µg m-2 h-1 ermittelt, die einen Zusammenhang zu den Wasserständen, Bodentemperaturen, O2- und DOC-Gehalten im Moorwasser zeigten

Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus

Background: Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. Methods: A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. Results: There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. Conclusions: The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice. (C) 2018 S. Karger AG, Base

Modeling denitrification in aquatic sediments

Author Posting. © The Author(s), 2008. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Biogeochemistry 93 (2009): 159-178, doi:10.1007/s10533-008-9270-z.Sediment denitrification is a major pathway of fixed nitrogen loss from aquatic systems. Due to technical difficulties in measuring this process and its spatial and temporal variability, estimates of local, regional and global denitrification have to rely on a combination of measurements and models. Here we review approaches to describing denitrification in aquatic sediments, ranging from mechanistic diagenetic models to empirical parameterizations of nitrogen fluxes across the sediment-water interface. We also present a compilation of denitrification measurements and ancillary data for different aquatic systems, ranging from freshwater to marine. Based on this data compilation we reevaluate published parameterizations of denitrification. We recommend that future models of denitrification use (1) a combination of mechanistic diagenetic models and measurements where bottom waters are temporally hypoxic or anoxic, and (2) the much simpler correlations between denitrification and sediment oxygen consumption for oxic bottom waters. For our data set, inclusion of bottom water oxygen and nitrate concentrations in a multivariate regression did not improve the statistical fit.Financial support for AEG to work on the manuscript came from NSF NSF-DEB-0423565. KF, DB and DDT acknowledge support from NOAA CHRP grant NA07NOS4780191

Impacts of 1.5°C Global Warming on Natural and Human Systems

An IPCC Special Report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate povert

Pilotprojekt ”Dendro-databas” i SEAD : April 2012-juni 2012

Pilotprojektet ”Dendro-databas” är ett samarbetsprojekt mellan det Nationella laboratoriet för vedanatomi och dendrokronologi vid Lunds universitet och SEAD-projektet vid Miljöarkeo-4logiska laboratoriet, Umeå universitet. Tillsammans arbetar man med utvecklingen av en da-tabas för dendrokronologiska data som kommer att hanteras och förmedlas via SEAD:s data-basverktyg. I detta arbete ingår både systemutveckling för att anpassa SEAD:s struktur för nya datamängder och inmatning av omfattande testdataserier.SEAD - The Strategic Environmental Archaeology Databas